Granulomatous disease: Difference between revisions

Revision as of 15:10, 2 November 2022

Background

Granulomatous inflammation is chronic inflammation that involves macrophages and T lymphocytes to wall off an infectious organism
T cells are activated and in turn activate macrophages, which undergo morphological changes to become more epithelioid
Creates two main types of granulomas: foreign body granulomas, and immune ganulomas
- In immune granulomas, macrophages active T cells to produce IL-2

Differential Diagnosis

Infections
Mycobacteria
- Tuberculosis: caseating granulomas, with acid-fast bacilli
- Leprosy: non-caseating granulomas, with acid-fast bacilli in macrophages
- Non-tuberculous mycobacteria
- Buruli ulcer (Mycobacterium ulcerans)
- BCG vaccination
Fungi: histoplasmosis, coccidiomycosis, blastomycosis, sporotrichosis, aspergillosis
, cryptococcosis
Protozoa: toxoplasmosis, schistosomiasis
Spirochetes
- Syphilis: gummas, which contain a wall of histiocytes, plasma cell infiltrate, and necrotic central cells without loos of cellular outline
- Treponema carateum
- Treponema pertenue
Bacteria
- Cat scratch disease: rounded or stellate granulomas with central granular debris and neutrophils; giant cells are uncommon
- Brucella, Yersinia, Whipple diseaes
Vasculitis: GPA, eGPA, lymphomatoid vasculitis, polyarteritis nodosa, bronchocentric vasculitis, giant cell arteritis, systemic lupus erythematosus
Other inflammatory disorders:
- Sarcoidosis: non-caseating granulomas with abundant activated macrophages
- Crohn disease: occasional non-caseating granulomas in intestinal wall
- Primary biliary cirrhosis, hepatic granulomatous disease, Langerhan granulomatosis, Peyronie disease, Blau syndrome, hypogammaglobulinemia, Langerhan cell histiocytosis, immune complex disease
Leukocyte oxidase defects: chronic granulomatous disease
Hypersensitivity pneumonitis: farmer's lung, bird fancier's lung, mushroom worker's lung, suberosis (cork dust), bagassosis, maple bark stripper's lung, paprika splitter's lung, coffee bean lung, Spatlese lung
Chemical exposures: beryllium, zirconium, silica, starch, talc
Neoplasms: carcinoma, reticulosis, pinealoma, dysgerminoma, seinoma, reticulum cell sarcoma, malignant nasal granuloma
Miscellaneous: lymphogranuloma, Kikuchi syndrome

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 == Differential Diagnosis ==
+* Infections
-* [[Tuberculosis]]: caseating granulomas, with acid-fast bacilli
+* Mycobacteria
-* [[Leprosy]]: non-caseating granulomas, with acid-fast bacilli in macrophages
+** '''[[Tuberculosis]]''': caseating granulomas, with acid-fast bacilli
-* [[Syphilis]]: gummas, which contain a wall of histiocytes, plasma cell infiltrate, and necrotic central cells without loos of cellular outline
+** '''[[Leprosy]]:''' non-caseating granulomas, with acid-fast bacilli in macrophages
-* [[Cat scratch disease]]: rounded or stellate granulomas with central granular debris and neutrophils; giant cells are uncommon
+** [[Non-tuberculous mycobacteria]]
-* [[Sarcoidosis]]: non-caseating granulomas with abundant activated macrophages
+** [[Buruli ulcer]] ([[Mycobacterium ulcerans]])
-* [[Crohn disease]]: occasional non-caseating granulomas in intestinal wall
+** BCG vaccination
+* Fungi: [[histoplasmosis]], [[coccidiomycosis]], [[blastomycosis]], [[sporotrichosis]], aspergillosis
+* , [[cryptococcosis]]
+* Protozoa: [[toxoplasmosis]], [[schistosomiasis]]
+* Spirochetes
+** '''[[Syphilis]]''': gummas, which contain a wall of histiocytes, plasma cell infiltrate, and necrotic central cells without loos of cellular outline
+** [[Treponema carateum]]
+** [[Treponema pertenue]]
+* Bacteria
+** '''[[Cat scratch disease]]''': rounded or stellate granulomas with central granular debris and neutrophils; giant cells are uncommon
+** [[Brucella]], [[Yersinia]], [[Whipple diseaes]]
+* Vasculitis: [[GPA]], [[EGPA]], [[lymphomatoid vasculitis]], [[polyarteritis nodosa]], [[bronchocentric vasculitis]], [[giant cell arteritis]], [[systemic lupus erythematosus]]
+* Other inflammatory disorders:
+** '''[[Sarcoidosis]]''': non-caseating granulomas with abundant activated macrophages
+** [[Crohn disease|'''Crohn disease''']]: occasional non-caseating granulomas in intestinal wall
+** [[Primary biliary cirrhosis]], [[hepatic granulomatous disease]], [[Langerhan granulomatosis]], [[Peyronie disease]], [[Blau syndrome]], [[hypogammaglobulinemia]], [[Langerhan cell histiocytosis]], [[immune complex disease]]
+* Leukocyte oxidase defects: [[chronic granulomatous disease]]
+* [[Hypersensitivity pneumonitis]]: farmer's lung, bird fancier's lung, mushroom worker's lung, suberosis (cork dust), bagassosis, maple bark stripper's lung, paprika splitter's lung, coffee bean lung, Spatlese lung
+* Chemical exposures: beryllium, zirconium, silica, starch, talc
+* Neoplasms: carcinoma, reticulosis, pinealoma, dysgerminoma, seinoma, reticulum cell sarcoma, malignant nasal granuloma
+* Miscellaneous: [[lymphogranuloma]], [[Kikuchi syndrome]]
+== Further Reading ==
+* James DG. A clinicopathological classification of granulomatous disorders. ''Postgrad Medical J''. 2000;76:457-465. doi: [https://doi.org/10.1136/pmj.76.898.457 10.1136/pmj.76.898.457]